United States District Court, N.D. Oklahoma
OPINION AND ORDER
the Court is Plaintiff's Motion for Partial Summary
Judgment (Doc. 17).
April 2, 2012, Plaintiff Jennifer Coats became employed as a
staff nurse with Cottage Health Care (“Cottage”).
Plaintiff became a participant in Cottage's employee
welfare benefit plan (the “Plan”), which is
governed by the Employee Retirement Income Security Act of
1974 (“ERISA”). The Plan includes long-term
disability (“LTD”) benefits funded by Defendant
Reliance Standard Life Insurance Company
(“Reliance”) through Group Policy No. LSC 97,
200. The Plan provides that Reliance “shall serve as
the claims review fiduciary with respect to the insurance
policy and the Plan”; shall “determine
eligibility for benefits”; and shall make
“complete, final and binding decisions on all
parties.” (AR 18.)
October 19, 2013, Plaintiff suffered an on-the-job back
injury and has not returned to work since that time.
Plaintiff submitted a claim for LTD benefits with Reliance on
March 24, 2015. By letter dated June 11, 2015, Reliance
approved the claim and granted Plaintiff $2, 194.96 in
monthly LTD benefits.
the award was insufficient, Plaintiff filed an administrative
appeal of the adverse benefit determination on December 3,
2015. On January 25, 2016, outside the 45-day deadline in the
relevant ERISA regulation, Reliance sent a letter to
We are required to make a decision within 45 days of the date
of your appeal but are allowed an additional 45 days if
circumstances do not permit us to make a decision within the
initial 45 day time frame. Please allow this letter to serve
as notice of our intention to take beyond 45 days to make a
final decision on your appeal. As we are still in the process
of completing our review, we will be contacting you in the
near future with an update or to inform you if additional
information will be required.
April 5, 2016, having heard nothing from Reliance regarding
her LTD claim,  Plaintiff filed the instant case in Tulsa
County, alleging underpayment of ERISA benefits and breach of
fiduciary duty. Plaintiff alleges that Reliance failed to
adjudicate her appeal in accordance with the Plan or
applicable law, that the appeal was deemed denied and
exhausted, and that her civil action was permissible to
recover underpaid amounts. Reliance received process in this
case sometime between April 8 and April 11, 2016. On April
20, 2016, Reliance denied the appeal. On April 27, 2016,
Reliance removed the case to this Court, and the Court set a
briefing schedule governing the preliminary issue of the
proper standard of review.
before the Court is Plaintiff's motion for partial
summary judgment on the question of the proper standard of
review. Based on undisputed facts in the administrative
record, Plaintiff contends that Reliance resolved
Plaintiff's appeal outside of ERISA's mandated
deadlines. According to Plaintiff, this violation negates the
“arbitrary and capricious” standard normally
applied and results in a de novo standard of review. Reliance
does not dispute that its decision was untimely but argues:
(1) untimeliness is not a procedural irregularity that alters
the standard of review; and, alternatively, (2) a
“substantial compliance” exception applies
because Plaintiff “was not prejudiced by the timing of
the appeal decision.” (Resp. to Mot. for Partial Summ.
Summary Judgment Standard
judgment is proper only if “there is no genuine issue
as to any material fact, and the moving party is entitled to
judgment as a matter of law.” Fed.R.Civ.P. 56(c). The
moving party bears the burden of showing that no genuine
issue of material fact exists. See Zamora v. Elite
Logistics, Inc., 449 F.3d 1106, 1112 (10th Cir. 2006).
The Court resolves all factual disputes and draws all
reasonable inferences in favor of the non-moving party.
Id. However, the party seeking to overcome a motion
for summary judgment may not “rest on mere
allegations” in its complaint but must “set forth
specific facts showing that there is a genuine issue for
trial.” Fed.R.Civ.P. 56(e). The party seeking to
overcome a motion for summary judgment must also make a
showing sufficient to establish the existence of those
elements essential to that party's case. See Celotex
Corp. v. Catrett, 477 U.S. 317, 323-33 (1986).
Does Untimeliness of Reliance's Decision Alter the
Standard of Review?
Reliance does not dispute that its decision was untimely, the
first question presented is purely legal - whether the
untimeliness of its decision alters the arbitrary and
capricious standard of review. If a benefit plan gives the
administrator discretionary authority to determine
eligibility for benefits or to construe the terms of the
plan, such as the Plan at issue here, a court ordinarily
employs a deferential “arbitrary and capricious”
standard of review. LaAsmar v. Phelps DodgeCorp. Life, Accidental Death & Dismemberment &
Dependent Life Ins. Plan, 605 F.3d 789, 796 (10th Cir.
2010) (citing Firestone Tire & Rubber Co. v.
Bruch, 489 U.S. 101, ...